Bopp S, Lucke K, Hille U
Tagesklinik Universitätsallee, Augenabteilung, Bremen, Germany.
Graefes Arch Clin Exp Ophthalmol. 1997 Jun;235(6):362-71. doi: 10.1007/BF00937285.
Vitreous surgery for Idiopathic macular holes can result in both anatomic closure of the hole and visual improvement. In some patients even normal visual acuity is achieved. Postoperative visual field loss is a newly recognized complication. This prospective study evaluates the frequency and significance of scotomas after vitrectomy with gas tamponade for stage I-IV macular holes.
Over a period of 10 months, a consecutive series of 30 patients and 31 eyes with macular holes underwent pre- and postoperative automatic perimetry (Octopus 07, 70 degrees) and macular perimetry (Octopus M1, 24 degrees) to characterize the pattern of visual field defects after vitrectomy with gas tamponade. Success rates were evaluated and complications were analyzed.
Anatomic success after one surgical procedure was achieved in 85% of cases, visual improvement in 58%. Some 70.1% of patients had peripheral scotomas postoperatively; some of these were highly symptomatic and others were detected by visual field testing only. The most consistently affected areas were the temporal and lower periphery of the visual field. The central visual field, however, was not disturbed.
Visual field loss after otherwise successful surgery for macular holes is an unexpectedly frequent and serious complication. The authors discuss various factors that may contribute to the postoperative scotomas. From the localization of the scotomas it seems most likely that they are caused by the persistent pressure of the gas bubble on the peripheral retina. Further investigations are necessary to confirm this hypothesis, and ways must be found to avoid this complication in order to be able to proceed with this otherwise promising new indication group for vitreous surgery.
特发性黄斑裂孔的玻璃体手术可使裂孔实现解剖学闭合并改善视力。在一些患者中甚至可达到正常视力。术后视野缺损是一种新发现的并发症。这项前瞻性研究评估了玻璃体切除联合气体填塞治疗Ⅰ-Ⅳ期黄斑裂孔后暗点的发生率及意义。
在10个月的时间里，对连续的30例患者的31只患有黄斑裂孔的眼睛进行了术前和术后自动视野检查（Octopus 07，70度）和黄斑视野检查（Octopus M1，24度），以确定玻璃体切除联合气体填塞术后视野缺损的模式。评估成功率并分析并发症。
85%的病例在一次手术操作后获得解剖学成功，58%的病例视力得到改善。约70.1%的患者术后出现周边暗点；其中一些症状严重，另一些仅通过视野检查发现。最常受影响的区域是视野的颞侧和下方周边。然而，中心视野未受干扰。
黄斑裂孔手术在其他方面成功后出现的视野缺损是一种意外频发且严重的并发症。作者讨论了可能导致术后暗点的各种因素。从暗点的定位来看，似乎最有可能是由气泡对周边视网膜的持续压迫所致。需要进一步研究来证实这一假设，并且必须找到避免这种并发症的方法，以便能够继续开展针对这一原本前景良好的玻璃体手术新适应证组别的治疗。
